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Robotic Prostatectomy

Robotic Prostatectomy

April 28, 2011 12:00 p.m. – 1:00 p.m. (EST)

Alok Shrivastava, MD - Urologist

Prostate cancer is the second leading cause of cancer deaths of men in the United States. Many of the latest urologic minimally invasive procedures, including robotic prostatectomy, were pioneered by Dr. Shrivastava himself as well as other Cleveland Clinic urologists.

Alok_Shrivastava_MD: We make 6 holes in the abdomen and remove the prostate through the bellybutton. A surgical robot is used.

Barry323: What are the benefits of having the robotic surgery versus the other procedures (open and laparoscopic)?

Alok_Shrivastava_MD: Faster recovery, less morbidity.

MadMan47: What are possible complications with the robot?

Alok_Shrivastava_MD: Risks of anesthesia, like any other surgery. Robotic procedure for prostate cancer has less perioperative medical complication rates than open prostatectomy, if the surgery is done by a trained, high volume surgeon. The complication rates come down if surgeon is doing more than 50 cases/year. The complications include infection, hernia, bleeding, lymphocele and other organ injury.

Jazz636: Will I have urinary incontinence after robotic surgery?

Alok_Shrivastava_MD: 50% of patients don't have urinary leakage after surgery, those who have leakage quickly become continent. The time taken varies with the age of the patient, prostate size and extent of surgical resection. 98% patients recover from continence in 12 weeks.

Jazz636: Will I need to have a blood transfusion with the robotic surgery?

Alok_Shrivastava_MD: Less blood loss is a major advantage of robotic surgery. No patients require blood during surgery. However <1% patient required blood after surgery due to continued oozing into the raw post-op surface.

Bond007: Will robotic prostatectomy help men with BPH (enlarged prostate), not just prostate cancer?

Alok_Shrivastava_MD: Most of the patients with enlarged prostate will experience complete resolution of their prostate symptoms. Some may continue to have symptoms related to secondary changes into their urinary bladder.

SamIam: Are nerves responsible for sexual function being spared during this surgery? What will happen if the nerves are not spared?

Alok_Shrivastava_MD: Depending on the cancer type, we can perform a very good nerve sparing. With bilateral nerve sparing and post-op penile rehab about 90% of patients can have intercourse after approved in a post-op follow-up of 1 year. If nerves have to be taken out due to cancer being aggressive then patient may experience ED requiring further treatment.

Cleveland_Clinic_Host: For those now joining us, we are currently chatting with Dr. Alok Shrivastava who is taking your questions about robotic prostatectomy. To ask a question, type in the box below and then click 'Ask'.

SamIam: Will I be able to take a bath after the surgery?

Alok_Shrivastava_MD: You can have a shower in 48 hrs. Bath and swimming will have to wait for 2 weeks.

Emilya55: Do the multiple incisions involved with the robotic prostatectomy increase the likelihood of adhesion and scar tissue complications afterwards?

Alok_Shrivastava_MD: No.

Avid16: How can you be sure that during the removal of a cancerous prostate that no cancer cells are released onto parts of the body?

Alok_Shrivastava_MD: : Prostate is removed with its capsule intact, if cancer is contained in prostate there is no risk of releasing cancer cells in body during surgery.

Jazz636: How long does the robotic surgery take?

Alok_Shrivastava_MD: The robotic part takes 90 min to 120 min. Total time in the operating room will be about 3 hrs.

Wilde369: Can I still have a baby after this surgery?

Alok_Shrivastava_MD: Not by natural means, you will have to get sperms banked before surgery and get assisted reproduction. After surgery, sperms can be obtained directly by aspiration form your testis for assisted reproduction.

MadMan47: Typically, how long does it take to fully recover and return to all normal activity?

Alok_Shrivastava_MD: It will take 2 weeks, except lifting weights > 20 lbs for 3 weeks, > 50 lbs for 3 months. Bicycling and horse back riding will also have to wait for 3 months.

Bond007: Will general anesthesia be required with the robotic surgery?

Alok_Shrivastava_MD: Yes.

Cmegan: What is the incidence of follow-up radiation required for men who have radical prostatectomy?

Alok_Shrivastava_MD: Depends on the Gleason type and pathologic staging. A Gleason 3+3, 3+4 organ confined usually doesn’t need adjuvant therapy. Higher-grade cancer and non organ confined disease may require adjuvant radiation. This is decided on individual case basis. The incidence varies 8-25% based on the aggressiveness and stage of cancer.

SamIam:Can lymph node also be removed during this procedure?

Alok_Shrivastava_MD: I perform lymph node dissection in almost all patients. In intermediate and high risk disease situations I perform extended pelvic lymph node dissection.

Cleveland_Clinic_Host: We have approximately 15 minutes left in the chat. We received a large amount of questions and we will continue to answer as many as possible. We apologize if we did not get to your question. If you have additional questions after the chat, please use our contact link clevelandclinic.org/webcontact to submit your questions.

Jazz636: How long is the hospital stay after surgery?

Alok_Shrivastava_MD: The hospital stay is 24 hours.

Wilde369: Will I need help at home after surgery?

Alok_Shrivastava_MD: You don't need a skilled help at home, but it is preferred to have someone around you just in case you experience any complications.

Wilde369: What are the extra measures that should be done after being discharged from the hospital from having the robotic surgery?

Alok_Shrivastava_MD: You should eat well and do light exercise, walk as much as you can, and stay away from stress.

Cleveland_Clinic_Host: We are getting ready to close for today. We will answer one more of your questions for today's chat. A large number of questions were received and we apologize if we did not get to your question. If you have additional questions, please go to clevelandclinic.org/health/livepersonchat to chat online with a health educator.

Cmegan: How do the cure rates compare between robotic prostatectomy, IMRT, and Seed Implantation?

Alok_Shrivastava_MD: Cure rates vary depending on the type of cancer. For low risk prostate cancer robotics and IMRT have equivalent cure rates. For intermediate and high risk cancer Robotics/open surgery have an upper hand to radiation. Radiation in these cases has to be supplemented by hormones.

Cleveland_Clinic_Host: I am sorry to say that our time Alok Shrivastava, MD is now over. Thank you again Dr. Shrivastava for taking the time to answer our questions today about robotic prostatectomy. If you are interested in scheduling an appointment with Dr. Shrivastava, or any one else from our Urology Department in Florida, please call toll free 877.463.2010.

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